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Become a patient advisor to the province

When you sign up to become a patient advisor to the Ontario healthcare system, we will:

  • ask for your feedback on certain policies and programs that affect patients and their families
  • invite you to participate in patient and family engagement events
  • keep you up to date on volunteer opportunities
What statement best describes you? Select all that apply.

Optional demographic questions

Your answers to these questions will help us tailor how we engage you on topics you’re interested in. Completing this section is optional.

What is your age?
What is your gender identity? Select all that apply.
Do you identify as Indigenous (First Nations, Métis, Inuit)?
Do you identify as a member of a racialized minority?
Do you identify yourself as (select all that apply):
Do you identify as Francophone?
Do you identify as a person with a disability?
What is the highest level of education that you have completed?
Which of the following best describes your current employment situation?
What is your combined household income (before taxes)?
How would you describe your community? Select all that apply.
In the past year, how many times have you or the person you are caring for had direct contact with a health care provider (e.g. a nurse, physician, clinic, hospital or other health care worker or organizations)?

Your privacy matters

Your privacy is important to us. Do not include any information that identifies a friend, family member or other person in your responses. If you choose to provide personal information in this form, the information will be handled according to our Privacy Statement.

Privacy statement

By clicking the submit button at the bottom of this form, you are indicating that you consent to the ministry’s collection of the personal information you have provided.

The ministry’s collection of this personal information is necessary for the proper administration of the provincial patient advisor initiative. It will be used by the ministry only for the purpose of asking for your feedback on certain policies and programs that affect patients and their families, inviting you to participate in patient and family engagement events, and keeping you up to date on patient engagement opportunities.

Your information will not be placed on mailing lists or released to any third party, except as may be authorized by law.

If you have any questions about the ministry’s collection or use of this information, please contact the Manager, Health System Quality and Funding Division, Ministry of Health and Long-Term Care:
phone: 416-325-3058
Hepburn Block 5th Floor- 80 Grosvenor St
Toronto ON M7A 1R3